February 9, 2010

President Barack Obama
The White House
1600 Pennsylvania Avenue NW
Washington, DC 20500

Dear Mr. President,

Physicians for a National Health Program, an organization of 17,000 doctors who support single-payer national health insurance, respectfully requests that you invite one or more of our representatives to participate in your White House health care session on Feb. 25.

We note that in your call for the meeting you urged Republicans, Democrats and health policy experts to gather, go over all the options and “walk through them in a methodical way so that the American people can see and compare what makes the most sense.”

We would like to offer several of our members as health policy experts for this important task.

As you may know, two key research studies that helped drive the health reform process forward this past year – one in the American Journal of Public Health that found 45,000 deaths annually are linked to lack of health insurance, another in the American Journal of Medicine that found 62 percent of personal bankruptcies are linked to medical bills and illness – were the work product of Harvard Medical School research teams guided by PNHP co-founders Drs. David Himmelstein and Steffie Woolhandler.

Drs. Himmelstein and Woolhandler, who are also primary-care physicians in Cambridge, Mass., have had several other groundbreaking studies published in our nation’s leading medical journals, including one in the New England Journal of Medicine that shows administrative costs consume 31 percent of U.S. health spending, most of it unnecessary. They have also frequently testified before Congress on their research. We urge that you invite them to participate in the Feb. 25 meeting.

The presence of Dr. Margaret Flowers, our congressional fellow, would also enhance the meeting. Dr. Flowers, a Maryland pediatrician, has met with numerous members of Congress and testified before two congressional committees last year about the urgent need for single-payer health reform.

Finally, we ask that you invite our president, Dr. Oliver Fein, to participate. Dr. Fein, an internist and professor of clinical medicine and clinical public health in New York City, attended the March 5 White House Summit on health care. He is a past vice president of the American Public Health Association.

Detailed biographies and contact information for each of these doctors are available upon request. Please feel free to call me (312-782-6006) or e-mail me (info@pnhp.org) should you need any additional information.

Sincerely,

Ida Hellander, M.D.
Executive Director

There are numerous ways to help groups already on the ground in Haiti. One of the best, Partners In Health, founded by Dr. Paul Farmer and several others, has been operating in the country since 1987. PIH operates clinics in Port au Prince and other major Haitian cities. With hospitals and a highly trained medical staff in place, Partners In Health is already bringing medical assistance and supplies to areas that have been hardest hit. Donations to PIH to help earthquake relief efforts will be quickly routed to the disaster.

You can donate online to the Partners in Health effort via this link:
http://www.pih.org/home.html

or send your contribution to:
Partners In Health,
P.O. Box 845578
Boston, MA 02284-5578

Trained medical staff are also urgently needed.

Nurses who want to volunteer in Haiti are being coordinated by the Registered Nurse Response Network (RNRN), a project of the 150,000-member National Nurses United (NNU), formed last month through the unification of the California Nurses Association and other nurses unions.  RNRN is hoping to have nurse volunteers on the ground in Haiti within the next few days and is coordinating with Haitian nurses on the effort.

Details are still being worked out, but those able to support the efforts of these nurses can get involved via:

* www.NationalNursesUnited.org to sign up to volunteer or donate
* @NationalNurses on twitter or by following: #haitiRN
* Call the RNRN hotline: 1-800-578-8225

The RNRN may also be able to help direct physicians who would like to volunteer in the recovery effort. Groups like Doctors without Borders are among those who are already treating victims.

Dr. Quentin Young, national coordinator of Physicians for a National Health Program, has written a foreword to a new book by Dr. Dani Filc of Israel.

Young writes (excerpt):

“As I sat down to read Dani Filc’s ‘Circles of Exclusion,’ I expected to learn a great deal about the Israeli health care system. What I did not expect was to find that this tiny country enmeshed in a seemingly intractable conflict in the Middle East would have so many lessons for the world’s most powerful nation – the United States.

“Several pages into this courageous book, it became clear that the issues Dr. Filc describes hold great relevance for those grappling with America’s ongoing health care crisis. The crisis in Israel and that in the United States are the result of the impact of neoliberal market policies that are currently being imposed on health care throughout the globe.

“In both countries we see a decline in concern and funding for public health and the exclusion of the poor racial and ethnic minorities from increasingly privatized health care systems in which the survival of profit-making enterprises seems to be the paramount concern. …

“For a public health advocate like myself, the message of this book is crystal clear. Obsessive preoccupation with free-market formulas are intensifying social and health care problems in industrialized countries, not resolving them. Of course, Filc shows us how this has happened is Israel, which because of its history puts a very specific spin on the problems of the poor, the old, racial and ethnic minorities, and the new migrant working class that crisscrosses the globe. Nonetheless, in Israel and elsewhere, preoccupations with profit are crowding out concerns for the classical social determinants of health and, as Dr. Filc points out over and over again, are not saving money but actually wasting it.”

The editors at Cornell University Press write:

“In its early years, Israel’s dominant ideology led to public provision of health care for all Jewish citizens-regardless of their age, income, or ability to pay. However, the system has shifted in recent decades, becoming increasingly privatized and market-based. In a familiar paradox, the wealthy, the young, and the healthy have relatively easy access to health care, and the poor, the old, and the very sick confront increasing obstacles to medical treatment.

“In ‘Circles of Exclusion,’ Dani Filc, both a physician and a human rights activist, forcefully argues that in present-day Israel, equal access to health care is constantly and systematically thwarted by a regime that does not extend an equal level of commitment to the well-being of all residents of Israel, whether Jewish, Israeli Palestinians, migrant workers, or Palestinians in the Occupied Territories.

“Filc explores how Israel’s adoption of a neoliberal model has pushed the system in a direction that gives priority to the strongest and richest individuals and groups over the needs of society as a whole, and to profit and competition over care. Filc pays special attention to the repercussions of policies that define citizenship in a way that has serious consequences for the health of groups of Palestinians who are Israeli citizens — particularly the Bedouins in the unrecognized villages — and to the ways in which this structure of citizenship affects the health of migrant workers.

“The health care situation is even more dire in the Occupied Territories, where the Occupation, especially in the last two decades, has negatively affected access to medical care and the health of Palestinians. Filc concludes his book with a discussion of how human rights, public health, and economic imperatives can be combined to produce a truly equal health care system that provides high-quality services to all Israelis.”

For Immediate Release

Dec. 22, 2009

Contact:
David Himmelstein, M.D.
Steffie Woolhandler, M.D., M.P.H.
Oliver Fein, M.D.
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

A national organization of 17,000 physicians who favor a single-payer health care system called on the U.S. Senate today to defeat the health care legislation presently before it and to immediately consider the adoption of an expanded and improved Medicare-for-All program.

While noting that the Senate bill includes some “salutary provisions” like an expansion of Medicaid, increased funding for community clinics and the curbing of some of the worst practices of the private insurance industry, the group says the negatives in the bill outweigh the positives.

The negatives, the group says, include the individual mandate requiring that people buy private insurance policies, large government subsidies to private insurers, new restrictions on abortion, the unfair taxing of high-cost health plans, and cuts of $43 billion in Medicare payments to safety-net hospitals. Moreover, at least 23 million people will remain uninsured when the plan finally takes effect, they said.

“We have concluded that the Senate bill’s passage would bring more harm than good,” the group said in a statement signed by its president, Dr. Oliver Fein, and two co-founders, Drs. David Himmelstein and Steffie Woolhandler.

Addressing the Senate in an open letter, they write: “We ask that you defeat the bill currently under debate, and immediately move to consider the single-payer approach – an expanded and improved Medicare-for-All program – which prioritizes the advancement of our nation’s health over the enhancement of private, profit-seeking interests.”

The full statement appears below.

To the Members of the U.S. Senate:

It is with great sadness that we urge you to vote against the health care reform legislation now before you. As physicians, we are acutely aware of the unnecessary suffering that our nation’s broken health care financing system inflicts on our patients. We make no common cause with the Republicans’ obstructionist tactics or alarmist rhetoric. However, we have concluded that the Senate bill’s passage would bring more harm than good.

We are fully cognizant of the salutary provisions included in the legislation, notably an expansion of Medicaid coverage, increased funds for community clinics and regulations to curtail some of private insurers’ most egregious practices. Yet these are outweighed by its central provisions – particularly the individual mandate – that would reinforce private insurers’ stranglehold on care. Those who dislike their current employer-sponsored coverage would be forced to keep it. Those without insurance would be forced to pay private insurers’ inflated premiums, often for coverage so skimpy that serious illness would bankrupt them. And the $476 billion in new public funds for premium subsidies would all go to insurance firms, buttressing their financial and political power, and rendering future reform all the more difficult.

Some paint the Senate bill as a flawed first step to reform that will be improved over time, citing historical examples such as Social Security. But where Social Security established the nidus of a public institution that grew over time, the Senate bill proscribes any such new public institution. Instead, it channels vast new resources – including funds diverted from Medicare – into the very private insurers who caused today’s health care crisis. Social Security’s first step was not a mandate that payroll taxes which fund pensions be turned over to Goldman Sachs!

While the fortification of private insurers is the most malignant aspect of the bill, several other provisions threaten harm to vulnerable patients, including:

* The bill’s anti-abortion provisions would restrict reproductive choice, compromising the health of women and adolescent girls.

* The new 40 percent tax on high-cost health plans – deceptively labeled a “Cadillac tax” – would hit many middle-income families. The costs of group insurance are driven largely by regional health costs and the demography of the covered group. Hence, the tax targets workers in firms that employ more women (whose costs of care are higher than men’s), and older and sicker employees, particularly those in high-cost regions such as Maine and New York.

* The bill would drain $43 billion from Medicare payments to safety-net hospitals, threatening the care of the 23 million who will remain uninsured even if the bill works as planned. These threatened hospitals are also a key resource for emergency care, mental health care and other services that are unprofitable for hospitals under current payment regimes. In many communities, severely ill patients will be left with no place to go – a human rights abuse.

* The bill would leave hundreds of millions of Americans with inadequate insurance – an “actuarial value” as low as 60 percent of actual health costs. Predictably, as health costs continue to grow, more families will face co-payments and deductibles so high that they preclude adequate access to care. Such coverage is more akin to a hospital gown than to a warm winter coat.

Congress’ capitulation to insurers – along with concessions to the pharmaceutical industry – fatally undermines the economic viability of reform. The bill would inflate the already crushing burden of insurance-related paperwork that currently siphons $400 billion from care annually. According to CMS’ own projections, the bill will cause U.S. health costs to increase even more rapidly than presently, and budget neutrality is to be achieved by draining funds from Medicare and an accounting trick – front-loading the new revenues while delaying most new coverage until 2014. As homeowners seduced into balloon mortgages have learned, pushing costs off to the future is neither prudent nor sustainable.

We ask that you defeat the bill currently under debate, and immediately move to consider the single-payer approach – an expanded and improved Medicare-for-All program – which prioritizes the advancement of our nation’s health over the enhancement of private, profit-seeking interests.

Oliver Fein, M.D., President
David U. Himmelstein, M.D., Co-founder
Steffie Woolhandler, M.D., M.P.H., Co-founder
Physicians for a National Health Program

************

Physicians for a National Health Program is an organization of 17,000 doctors who advocate for single-payer national health insurance. To contact a physician-spokesperson near you, visit www.pnhp.org/stateactions or call (312) 782-6006.

The New England Journal of Medicine (NEJM) has had a decades-old policy of financial disclosure by authors of editorials in order to “prevent financial interests from infringing on the editorial content of the Journal.”

This policy was grossly violated when the editors of the NEJM recently chose to publish an opinion piece by Senator Max Baucus titled “Doctors, Patients, and the Need for Health Care Reform” (Vol. 361:1817-1819, Nov. 5, 2009, No. 19) that included a statement by the author that he had no financial interests to disclose.

In the past year alone, Sen. Baucus has received payments from drug and health insurance companies many times in excess of the $10,000 limit which the Journal recognizes as significant to alter an author’s credibility. By failing to disclose those contributions to Journal readers, Sen. Baucus and the editors of the NEJM have violated their own code of ethics and disclosure meant to support the veracity of opinions and data presented in their journal.

Disclosure of the senator’s directly or indirectly received payments from health insurance and pharmaceutical companies would help readers understand why Sen. Baucus continues to support a government-subsidized, high-overhead, low-outcome private insurance industry operating parallel to and within Medicare insurance.

Disclosure of the senator’s receipt of such “contributions” from the health care sector might demonstrate why he supports a private health insurance industry that siphons away, via administrative overhead, hundreds of billions of dollars annually from physician subscribers to the NEJM, patients, clinics, therapists, and pharmacies.

In addition to failing to disclose in the NEJM the monies he has received from pharmaceutical and health insurance companies, Sen. Baucus failed to inform readers of his personal and his Senate Finance Committee’s continued support for (or acquiescence to) the following policies:

* A federal exemption for private health insurance companies from antitrust regulations.

* A prohibition on Medicare insurance establishing a drug formulary through competitive bidding.

* No federal grants to develop a single EMR and billing system for physicians, hospitals and therapists which would reveal clinical, preventative and surgical outcomes. Outcome revelations would crush the health insurance companies, and allow for free-market competition among doctors and hospitals based on quality and efficiency.

* Protection of private health insurance companies from medical malpractice lawsuits via federal ERISA laws.

* Part D taxpayer subsidies to health insurance and drug corporations.

* Medicare Advantage taxpayer subsidies to health insurance companies.

* Reckless and negligent medical rationing by private health insurance companies via their non-physician employees.

* A government ban on collective bargaining by physicians.

* An inability of Medicare to enlarge its limited risk pool beyond that of the oldest, sickest and most physically disabled citizens of our nation.

* Personal bankruptcies due to a medical illness.

* No real change in malpractice reform. Real malpractice reform would allow internists and family practitioners to fulfill their role as primary care physicians efficiently and productively, tackling dynamic illnesses without prematurely referring their sicker patients to expensive specialists without medical benefit.

By allowing Sen. Baucus to express his opinion without a comprehensive disclosure of the large sums he has received from health insurance and pharmaceutical companies or of his continued support of current health care policies, the editors of the NEJM have surrendered their objective status as an advocate of integrity in research and patient care.

Sincerely,

Howard A. Green, M.D., FACP, FAAD, FACMS

By A.R. Strobeck Jr.

In “The Cancer Generation,” Dr. John Geyman, physician and professor emeritus of family medicine at the University of Washington, focuses on the baby boomer generation in the United States and the virtual tsunami of cancer cases that is expected to hit this 79.5-million-member demographic as more of its members move into their “golden years.”

Geyman says he aims to examine “the changing landscape of cancer in the U.S., including the extent to which the marketplace fails patients with cancer care.” He takes a hard look at how well the present state of cancer care – particularly the financing of medical services – measures up to the task of providing quality, compassionate care to those who need it.

While he draws upon the latest academic research and the book is heavily footnoted, the material is presented in a popular, accessible way, including with the abundant use of tables and graphs.

The picture he draws is not pretty. The author believes that the outlook for cancer care is bleak, largely due to the unregulated “free market” economic policies that have come to dictate both access to, and delivery of, health care in the U.S. These policies have given rise to an astronomical increase in the costs of cancer care, with treatment costs are now rising by 20 percent each year. The rising costs are putting effective care out of reach of millions.

This problem is expected to worsen, the author says, noting that the Institute of Medicine projects the number of cancer cases will double between 2000 and 2050. Meanwhile, the annual cost of treating cancer is projected to reach $1.1 trillion by 2023, more than five times what we spend today.

As a result, the aging of the U.S. population “will lead to an increasing cancer burden, both for individuals and their families as well as for the health care system itself.”

Geyman acknowledges that treatments for cancer have improved, and today’s care can be effective in many cases. He points to the dramatic increase in the survival rate among children diagnosed with cancer, for example.

But lack of health insurance, or poor quality insurance, prevents people from getting access to and obtaining proper care. The chief culprit here, he says, is the private health insurance industry, which is more concerned with increasing its profits than in assuring access to care.

More generally, however, he believes that our present market-driven health care system cannot meet the coming surge in cancer cases without drastic changes in its structure, access, delivery and methods of financing.

Geyman sees a blind faith in technology in the U.S. as fueling an explosion of new technologies, even though there is much uncertainty as to the safety and efficacy of these innovations. Unfortunately, he asserts, due to the high stakes that come with cancer, patients facing it are “especially vulnerable to accepting treatment at whatever the risks or costs.” Thus the marketplace is “setting cancer policy by default,” i.e. most of our health care dollars are going into treatment and far too little into prevention.

Cancer survivors face special challenges, he writes. They are less likely to be employed. They face three kinds of barriers to care thrown in their way by private insurance: availability, affordability and adequacy. And if these barriers are not enough, private insurance companies sometimes will go to even greater lengths to deny coverage to those afflicted.

Survivors lucky enough to have insurance face much higher co-payments. In addition, insurance firms try to cap coverage or otherwise place limits on the amount of treatment. As a result, a cancer diagnosis is often a prelude to financial crisis and bankruptcy.

Cancer survivors without insurance often find it difficult to see a doctor or to have a regular source of care. Geyman notes that it is no wonder that uninsured and Medicaid patients often have cancer at a more advanced stage when it is diagnosed. In addition, most cancer survivors often have serious co-morbidities such as heart disease or diabetes, which also go untreated at a disproportionately higher rate.

Geyman argues that everyone needs accessibility to doctors if the mortality rate of cancer is to be reduced. Unfortunately, the policies of the private health insurance industry are heading in the opposite direction, leading to uncontrolled inflation of costs; growing unaffordability of premiums; decreasing levels of coverage; a bloated bureaucracy, contributing to the waste of 31 cents of every U.S. health care dollar on administrative costs; a shrinking market of only 59 percent of employers now offering health insurance; ineffective state and federal regulation; and growing insecurity and hardship in the general population.

Racial disparities also continue to take a heavy toll: for example, cancer mortality rates are 35 percent higher for African Americans than whites.

What’s his prescription for a cure? As step No. 1, Geyman recommends establishing a public health insurance system such as single-payer Medicare for All. Such a system would provide health care services “based on medical need, not ability to pay, ” and would “eliminate much of the inefficiency and waste of the private insurance industry and actually cost employers and individuals less than we are already paying for insurance and health care.”

He outlines additional measures like establishing a national, evidence-based clinical effectiveness program; more funding for cancer research; and the strengthening of the nation’s cancer workforce, especially in primary care and geriatric oncology.

Finally, Geyman reminds us of the ethical issues surrounding cancer care, citing Dr. Martin Luther King Jr., when he said, “Of all forms of inequality, injustice in health care is the most shocking and most inhuman…. Although social change cannot come overnight, we must always work as though it were a possibility in the morning.”

Reading and acting on this book will help bring about that better day.

A.R. Strobeck Jr. worked for many years in health care administration. He resides in Chicago.

By Diana Stritzel

I just wanted to say that I really enjoy reading your articles and feedback on what’s going on about health care in the U.S. I don’t remember how I found your list and subscribed to it, but I find it really useful to learn more about the system.

Being German by birth, I find it really awful what people here in the U.S. are being subjected to just to go and see a doctor. I’ve had people at my workplace telling me how horrible it must be that I don’t have the choice of doctor in my country of origin. I was like …What? I never had so many problems in any other country I’ve been in before.

The U.S. is the worst. (I’ve lived in United Kingdom, Italy, New Zealand and Australia.) My employer provides coverage, and not a bad one, as I’ve been told. Now, I’ve had nothing but trouble with the insurer (Aetna). I was on PPO plan before, but now I moved to my employer’s state (California) and I’m covered on Aetna’s HMO plan.

But for all plans I have to go online or call them first, and find a doctor which is in the network, so that Aetna covers it. In Europe I never had that problem, I can go to any doctor anywhere and I don’t need to ask or check with insurance first.

Then there’s the administrative effort required. Every time I go to a doctor, I have to fill out so much paperwork, and sign three statements that I will pay for all charges incurred in case my insurance doesn’t pay. As if that wouldn’t make you feel more miserable than you already are (seeking a doctor in the first place).

And after all that, I’ve still had bills coming to my house, which led me to call my insurance company and they told me I’ll have to pay these, because my doctor requested tests from a lab which is not in Aetna’s network. So now I have to be paranoid about each test the doctor wants to do, and ask the doctor to please use a lab which is covered by Aetna. Outrageous!

After my move to California I was unlucky enough to be in need of emergency room. They suggested I go for a follow-up in a couple of days. Since I hadn’t been to my “PCP” yet, and I live in San Diego, whereas Aetna send me a coverage card which stated that my PCP is in Los Angeles, when trying to change my PCP to one in San Diego I failed in three attempts (one online, and two by phone). Once I was in the doctor’s practice, they called to verify with Aetna that this was changed (because I only had the card which stated the L.A. doctor’s name), and Aetna’s employees said no. (I had been on the phone with them forever until they finally said yes, we’ve changed it.)

The doctor suggested I pay for the visit and claim it back, but I had learned from before (my PPO plan) that Aetna will find a way to never pay these back to me. So again I called them up and asked for changing my doctor. I was wondering why they added a doctor in L.A. in the first place as they had my correct address in San Diego.

Anyway, after subjecting me to lots of useless questions like “When are you planning to change your PCP again?” (which made me wanna cry…. I didn’t choose that doctor!), finally they said that they changed it, and I made them give verbal confirmation to the practice right away, so I could finally see a doctor.

I haven’t received any bills yet, but I’m wondering when they might come.

I think the system as a whole is really awful. Hard to see any light at all, with politicians taking the bribes from insurance companies and such statements as Obama’s below. [Editor’s note: the reference is to President Obama’s comment that moving to a single-payer system would be disruptive.] I don’t understand why Americans don’t fight more for health care, which is one of the most important things to have. The feeling of security that comes with a health care system like in the U.K. (where I studied and lived many years) is just not replaceable.

I for my part wish you all the best, and I do hope you will not stop fighting for your right to health care (yes, in my opinion it is a right which every human should have).

Thanks for your articles and the awareness you bring to this topic. I’m following Ralph Nader as well, and I do hope that despite all the ridiculing your media does to him, that maybe one day someone will listen and change the system. I hope I’ll see the day, I know for sure that I won’t be living in U.S. by then though.

Thanks and keep going!

Dr. Donald J. Palmisano, a past president of the American Medical Association, recently wrote that our country’s health care system “the finest in the world” and went on to say how a publicly financed health care system could ruin what has been built. He cites such potential horrors as long waits for specialists, bureaucratic intervention in medical decisions, and taxpayers bearing the burden of a government plan as reasons to oppose the creation of one.

I have one question for Dr. Palmisano: What country do you live in? In my country, America, we have the best doctors in the world. However, the system we have placed them into is stifling their ability to treat patients to the best of their ability.

Take wait times for specialists. We live in a country where 18 percent of the population lacks health insurance. This means that right from the start at least 46 million people have been cut out of the waiting line. Certainly this shortens the wait time for those of us with insurance, but at what cost in human life and health?

And if you want to go on anecdotal evidence, how do you explain the six-week wait I was told I had when I tried to make an appointment with an orthopedist for back pain?

How about the bureaucratic demons that are plaguing our doctors and patients now? Wait, aren’t these just called HMOs? Private health insurance in the U.S. interferes with the doctor-patient relationship all the time. Pre-approval for procedures, denial of payment, and pharmaceutical formularies – all of these are par for the course in the American health system.

According to the Commonwealth Fund, American doctors spend on average 142 hours annually interacting with health plans, at an estimated annual cost to physician practices of $31 billion, or $68,274 per physician. This works out to be about 3 hours per week. For primary care physicians the time is about 3.5 hours/week.

Now, Dr. Palmisano, if we divide this number by the average appointment time of 18.7 minutes, we see that doctors would be able to see an extra 11 patients per week if we did not have the administrative waste of our current system.

Finally, I agree with you that in these tough economic times, no one wants to saddle anything on taxpayers that they do not already pay. However, our country spent $2.4 trillion in 2008 on health care, with 46 percent coming from government money. This accounted for 17 percent of our GDP. The world’s second-largest spender was Switzerland, and they covered everyone by spending only 10.8 percent. We are already paying more for what we don’t get in the first place.

Our health system is wasteful and inefficient. I agree with you 100 percent when you say that reform should not weaken our health care. That is why I support a single-payer health program, like that in Taiwan, not Britain.

Taiwan spends only 6 percent of their GDP on health care, yet all their citizens are covered and get comprehensive, quality care. How do they do this? Simply put, they cut out all the administrative waste that is burdening the U.S. system. The government pays the bills, the doctors take care of the patients. It’s that simple.

The people there have free choice of physician, and the only thing that causes a wait time is the demand for the particular doctor. This is no different than trying to get an appointment with a high-end neurosurgeon here in the U.S.

Their system is publicly financed, but privately run. Were we to adopt such an approach here, very little would change in the work of our doctors except to lift from their shoulders the enormous paperwork burden that they presently carry. They wouldn’t have to worry about becoming government employees, for example, or told they can’t work in a given area.

Patients would have ultimate choice in provider. All doctors would be in “their plan,” including the one they are seeing now.

At the end of Dr. Palmisano’s article he asked, “Will we have a system that puts the patient in control with the doctor as trusted adviser, or a government-run system…?” My only response is: Why can’t we have both?

Ryan McIntyre is a second year medical student at Albany Medical College and an MPH candidate at SUNY Albany School of Public Health in Albany, NY. He is also a member of Physicians for a National Health Program. He can be reached at mcintyre.ryan@gmail.com.

By Nick Skala

Today the Congressional Progressive Caucus faces a choice. That choice is whether Members should maintain their unflinching support for single-payer, or to accede to intense political pressure to support the plan currently being developed in Congress under the direction of President Obama: a mandate for Americans to purchase an insurance plan from a massive new regulatory “exchange,” with one plan potentially being a “public option.”

The difference between these choices could not be more stark: single-payer has at its core the elimination of U.S.-style private insurance, using huge administrative savings and inherent cost control mechanisms to provide comprehensive, sustainable universal coverage.

The “public option” preserves all of the systemic defects inherent in reliance on a patchwork of private insurance companies to finance health care, a system which has been a miserable failure both in providing health coverage and controlling costs.

Elimination of U.S.-style private insurance has been a prerequisite to the achievement of universal health care in every other industrialized country in the world. In contrast, public program expansions coupled with mandates have failed everywhere they’ve been tried, both domestically and internationally.

Many progressives accept that the “public option” is inferior to a single-payer system, yet support it because of its perceived political expedience. It is my aim today to convince you that the “public option” program currently being developed is not only bad health policy, but bad health politics.

On two separate occasions last month, physicians and nurses were dragged from the Senate Finance Committee in handcuffs for demanding that single-payer be considered in our nation’s health reform debate. These were American doctors and nurses, people who care for patients, people who want to practice medicine, not protest and disrupt Congress.

But these professionals risked their careers and their freedom. They did this not because they thought that the “public option” was “good” and single-payer “better.” They did it because they are firmly convinced, by well-established health policy science, that the so-called “public option” has no hope of remedying the systemic defects that cause their patients to suffer and die, sometimes before their very eyes.

Millions of dollars have been spent by political advocacy groups to commission polls and statistics “proving” that their health reform is “politically feasible.” Yet political winds do not make good health policy. Careful examination of science and experience do. And it is in the science and experience that we see that single-payer offers the only way to truly comprehensive, universal and sustainable health care, and that “public option” schemes offer only more of the same: tens of millions of uninsured, rapidly deteriorating coverage, an epidemic of medical bankruptcy, and skyrocketing costs that will eventually cripple the system.

First, because the “public option” is built around the retention of private insurance companies, it is unable – in contrast to single-payer – to recapture the $400 billion in administrative waste that private insurers currently generate in their drive to fight claims, issue denials and screen out the sick. A single-payer system would redirect these huge savings back into the system, requiring no net increase in health spending.

In contrast, the “public option” will require huge new sources of revenue, currently estimated at around $1 trillion over the next decade. Rather than cutting this bloat, the public option adds yet another layer of useless and complicated bureaucracy in the form of an “exchange,” which serves no useful function other than to police and broker private insurance companies.

Second, because the “public option” fails to contain the cost control mechanism inherent in single-payer, such as global budgeting, bulk purchasing and planned capital expenditures, any gains in coverage will quickly be erased as costs skyrocket and government is forced to choose between raising revenue and cutting benefits.

Third, because of this inability to control costs or realize administrative savings, the coverage and benefits that can be offered will be of the same type currently offered by private carriers, which cause millions of insured Americans to go without needed care due to costs and have led to an epidemic of medical bankruptcies.

Supporters of incremental reform once again promise us universal coverage without structural reform, but we’ve heard this promise dozens of times before.

Virtually all of the reforms being floated by President Obama and other centrist Democrats have been tried, and have failed repeatedly. Plans that combined mandates to purchase coverage with Medicaid expansions fell apart in Massachusetts (1988), Oregon (1992), and Washington state (1993); the latest iteration (Massachusetts, 2006) is already stumbling, with uninsurance again rising and costs soaring. Tennessee’s experiment with a massive Medicaid expansion and a public plan option worked – for one year, until rising costs sank it.

The Federal Employee Health Benefit Program (the model for a health insurance exchange) leaves hundreds of thousands of federal workers uninsured, and has proven unable to contain costs.

Negative results in a recent series of randomized trials explodes the hope that chronic disease management will cut costs. And the CBO has thrown a wet blanket on the notion that electronic medical records save money.

As Drs. David Himmelstein and Steffie Woolhandler, co-founders of Physicians for a National Health Program, have remarked, a public plan option does not lead toward single-payer, but toward the segregation of patients, with profitable ones in private plans and unprofitable ones in the public plan. A quarter-century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry-picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan – which started as a single-payer system for seniors and have now become a funding mechanism for HMOs – and a place to dump the unprofitably ill.

Progressive supporters of the “public option” readily concede that single-payer is a superior system. Indeed, their response to evidence that their plan won’t work is to commission more charts and graphs emphasizing its political feasibility.

The “public option” is truly the embodiment of health policy designed by sound bytes, cobbled together from snippets of information gathered from focus groups and public opinion polls, and centered around well-polling buzzwords such as “choice” and “shared responsibility.”

Such a plan may be enough to excite the political classes in Washington, who care more about what they think can pass the Congress than what will actually deliver universal, comprehensive health care for all. But doctors and nurses, the people who actually work in the health system, see right through it. They are going to jail because they know that this plan won’t work for their patients.

Nobody is going to jail for the “public option,” because the American people cannot be inspired by band-aids and half-measures it is impossible to believe in.

These doctors and nurses are the manifestation of a social movement, millions strong, that is waiting to be mobilized by the leadership of the Members in this room. Polls consistently show that two-thirds of the American people want single-payer. At a recent hearing in Montana convened by Sen. Max Baucus, only 10 people of three hundred said they were happy with the insurance they have. Sixty percent of physicians support single-payer, as do the U.S. Conference of Mayors and 39 state labor federations and hundreds of local unions across the country.

We’re told that holding out for single-payer is politically unwise, but to compromise and accept a bad plan at precisely the time when popular support and grassroots energy are on the side of true reform is the real political miscalculation.

The history of great social achievement is rife with instances in which the forces of institutionalized power told social movements – as they now tell this one – that what they wanted was too much, or too fast, or too soon. I think, of course, of the abolition of human slavery, the enfranchisement of women, the Civil Rights Movement, Social Security, the minimum wage, an end to child labor. In each of these instances, social movements held fast to their principles and soon discovered that they had been told was “politically unfeasible” one moment was political reality the next.

We currently have a better chance to pass single-payer than Lyndon Johnson had when he passed Medicare. Unlike the public option, single-payer – because it holds the potential to finally realize universal, equitable health care – can be a vehicle to inspire the American people for progressive change.

The voices of doctors and nurses can achieve extraordinary resonance when they speak selflessly in their patients’ interest. But your leadership is crucial to inspire the American people. It is my hope that you’ll see fit to provide it.

Click here for a printable version of the handout below.

The “Public Option” Fails as Health Politics:

But Getting “Something” is Better than Getting “Nothing,” Isn’t It?

Not if that “something” makes it more difficult to reach a real solution and ensures temporary relief will be followed by prolonged suffering. The “public option” may allow some people to buy inadequate insurance products for a short time. But such a system will quickly be crushed by the weight of rising health care costs, as Medicaid, SCHIP and dozens of state initiatives have been.

In addition, expending political capital on reforms that we know will fail makes the public cynical and gives ammunition to those who say that the government cannot create effective programs. Hence, any attempt at real reform is delayed, usually by decades. The minor temporal relief that reformers might get by acquiescing to insurance industry demands is simply not worth the continued suffering of the American people.

But Such a System to Could be a “Step” Towards Universal Coverage, Right?

No. Enacting phony “universal coverage” has not brought any state closer to a single-payer system. Since the early 1990s, Minnesota, Oregon, Maine, Florida, Utah, Washington, California, Vermont and Massachusetts have been among the states that have attempted to “patch-up” their fundamentally fl awed systems while retaining a place for insurance companies. All have failed. Upon passage, incremental reforms in each of these states were hailed by politicians and the media as a “step toward universal coverage.” Yet despite all the claims of pragmatism, incremental reformers have been unable to shepherd through meaningful change in nearly four decades of trying. And while reformers in these states continue to wait for the next “step,” residents continue to suffer.

The definition of insanity is to repeat an action expecting a different result. This is exactly what we have done in continuing to advocate incremental reforms as “steps” toward single-payer. What Americans need is not more proposals for patchwork reforms. We need leaders willing to stand up for the only solution that will work.

Nick Skala is a member of Physicians for a National Health Program (www.pnhp.org).

The Obama administration is in peril of committing a colossal blunder. Powerful organizations, representing the major health industry groups, sent a letter to the president and subsequently met with him, pledging to reduce health cost inflation in the coming years.

The signers include America’s Health Insurance Plans, the Advanced Medical Technology Association, the American Hospital Association and the Pharmaceutical Research and Manufacturers of America.

Yes, health care costs are soaring and we urgently need reform. But these Johnny-come-lately rescuers are literally the cause of the crisis. Accepting their pledge of remedy is naïve and dangerous.

These corporate giants are legally bound to maximize return to their investors, which they do very well. They are the cause of the disarray in health care: double-digit inflation, 50 million uninsured and widespread medical bankruptcies.

How can any concerned administration rely on these culprits?

There is, of course, a different, proven remedy: single-payer national health insurance, an improved Medicare for all. Single payer slashes administrative costs, allowing us to provide universal, quality care for no more than we spend now. It also controls costs.

Can we hope President Obama will renew his earlier support for single payer and not accept the fool’s gold now proffered by the very malefactors who created the current crisis?

Quentin D. Young, M.D., M.A.C.P.
National Coordinator, Physicians for a National Health Program